Compulsory treatment should only be used as a last resort, according to a majority of mental health groups.

They are worried that proposed reforms to mental health legislation, dubbed the biggest shake-up in the sector for 40 years, represent a step backwards in the movement towards increased rights for patients.

The National Schizophrenia Fellowship (NSF), one of a number of groups handing in a 20,000-signature petition calling for a legal right to care and treatment, said the Green Paper was "a missed opportunity".

Chief executive Cliff Prior stated: "Instead of moving further forward, the government is harking back to compulsion as a first resort rather than raising the standard of modernisation, quality and choice. Compulsion should be a last resort."

The NSF says a survey of patients shows they fear compulsory care and treatment orders (CCTOs) could deter people from seeking help.

Patients want more rights to treatment, such as access to newer drugs, says the NSF. One in four of its members say they have been turned away from hospital in a crisis.

SANE also wants the CCTOs to be used only as a last resort "with full safeguards", in a clinical setting and "wherever possible as part of a 'contract' between the patient and services".

Chief executive Marjorie Wallace said: "Compulsion should not just be imposed on the few patients for whom it might be necessary, but on the mental health services to provide more holistic, individually tailored treatments whether in hospital or the community."

She added that she was concerned the proposals were not backed by sufficient resources.

"The monies being proposed will hardly meet the current need, let alone reduce the strain on a system crumbling under the pressure," she said.

The King's Fund said the focus on compulsion would not help the majority of mentally ill people, who still faced widespread discrimination.

It said: "Community care should help people with mental illnesses to live ordinary lives, not contain and control them."

Alliance

An alliance of 15 mental health, disability and healthcare groups opposed to CCTOs have raised concerns about how the orders will be enforced.

The groups, including Mind and the Mental Health Foundation, are worried CCTOs might deter people from accessing services.

The alliance is also concerned about the focus on medication, rather than support.

However, Mind welcomed the introduction of rights to needs assessment, independent advocacy for detained patients, advance agreements on the care offered to patients and safeguards for treatment such as electro-convulsive therapy.

'Modern document'

However, the Zito Trust, which was set up following the killing of Jonathan Zito by schizophrenic Christopher Clunis, welcomed the reforms.

Its director Michael Howlett said the Green Paper was "a modern document which will enable community care to work effectively where it does not at the moment".

He said the 1983 Mental Health Act, which the proposals would replace, was "out-of-date" and needed updating to deal with the move from hospital treatment to community care.

"It is illogical to have powers to treat people forcibly in hospital and not in the community," said Mr Howlett.

However, he added that CCTOs would need to be supported by closer working between the different agencies involved in looking after community care patients and additional resources.

The Royal College of Psychiatrists said it was worried that there would not be enough money available to back the reforms, particularly in the light of problems recruiting psychiatric staff and a shortage of hospital beds for the most seriously ill.

And the Royal College of Nursing said it was concerned that CCTOs should "not be used as a substitute for adequate mental health services" or a response to a shortage of hospital beds.